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Rn Rac Auditor Jobs in Virginia (NOW HIRING)

Regency Care of Arlington

MDS Coordinator (RN)

Arlington, VA

$42.50 - $51.50/hr

RAC Certification is preferred. Major Duties and Responsibilities * Coordination of the facility ... Auditing medical records for the presence of supporting documentation for all items coded on the ...

Regency Care of Arlington

MDS Coordinator (RN)

Arlington, VA

$42.50 - $51.50/hr

RAC Certification is preferred. Major Duties and Responsibilities * Coordination of the facility ... Auditing medical records for the presence of supporting documentation for all items coded on the ...

Regency Care of Arlington

MDS Coordinator (RN)

Arlington, VA · On-site

$42.75 - $51.75/hr

RAC Certification is preferred. Major Duties and Responsibilities * Coordination of the facility ... Auditing medical records for the presence of supporting documentation for all items coded on the ...

Regency Care of Arlington

MDS Coordinator (RN)

Arlington, VA · On-site

$42.50 - $51.50/hr

RAC Certification is preferred. Major Duties and Responsibilities * Coordination of the facility ... Auditing medical records for the presence of supporting documentation for all items coded on the ...

UHS

DRG Nurse Auditor

Richmond, VA

The Atlantic Region CBO is seeking a dynamic and talented DRG Nurse Auditor with clinical case ... Qualifications Position Requirements: * RN or LPN licensure in good standing is required. BSN ...

UHS

DRG Nurse Auditor

Richmond, VA

The Atlantic Region CBO is seeking a dynamic and talented DRG Nurse Auditor with clinical case ... Qualifications Position Requirements: * RN or LPN licensure in good standing is required. BSN ...

UHS

DRG Nurse Auditor

Richmond, VA · On-site

The Atlantic Region CBO is seeking a dynamic and talented DRG Nurse Auditor with clinical case ... Qualifications Position Requirements: * RN or LPN licensure in good standing is required. BSN ...

UHS

DRG Nurse Auditor

Richmond, VA · On-site

The Atlantic Region CBO is seeking a dynamic and talented DRG Nurse Auditor with clinical case ... Qualifications Position Requirements: * RN or LPN licensure in good standing is required. BSN ...

Mission Hospital

RN Case Manager

Roanoke, VA

Promoting HCA Healthcare's values of compassion, respect, and excellence through every patient and family interaction What qualifications you will need: * * (RN) Registered Nurse * Associate Degree ...

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Rn Rac Auditor information

See Virginia salary details

$19

$32

$46

How much do rn rac auditor jobs pay per hour?

As of Jun 14, 2026, the average hourly pay for rn rac auditor in Virginia is $32.71, according to ZipRecruiter salary data. Most workers in this role earn between $28.61 and $35.77 per hour, depending on experience, location, and employer.

What is an RN RAC Auditor job?

An RN RAC (Recovery Audit Contractor) Auditor is a registered nurse who reviews medical records to ensure compliance with Medicare and Medicaid billing regulations. They analyze documentation, identify improper payments, and help healthcare providers correct billing errors. Their role is crucial in preventing fraud, ensuring accurate reimbursement, and improving healthcare compliance.

What are the key skills and qualifications needed to thrive in the Rn Rac Auditor position, and why are they important?

To thrive as an RN RAC Auditor, you need a current RN license, strong clinical background, and in-depth knowledge of Medicare and healthcare reimbursement systems. Familiarity with tools such as electronic health records (EHRs), the Resident Assessment Instrument (RAI), and coding software like ICD-10 is crucial, and certification such as RAC-CT (Resident Assessment Coordinator-Certified) is often preferred. Attention to detail, analytical thinking, and strong written and verbal communication are valuable soft skills for auditing complex medical records and collaborating with interdisciplinary teams. These competencies ensure accurate compliance, optimal reimbursement, and the maintenance of high regulatory standards within healthcare organizations.

What are some common challenges faced by RN RAC Auditors in their daily work?

RN RAC Auditors often encounter challenges such as keeping up with frequently changing Medicare regulations, ensuring meticulous accuracy in clinical documentation, and coordinating with various healthcare professionals to resolve discrepancies. The role may require balancing multiple audits simultaneously and adapting quickly to new software or compliance standards. Successful RAC Auditors rely on strong organizational skills and up-to-date industry knowledge to navigate these challenges and support their facility’s compliance and reimbursement objectives. Most auditors work closely with MDS coordinators, billing departments, and clinical teams, making clear communication and teamwork essential. Staying proactive with ongoing education and training can also help ease these hurdles and contribute to long-term career growth.

What are popular job titles related to Rn Rac Auditor jobs in Virginia? For Rn Rac Auditor jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Rn Rac Auditor jobs in Virginia look for? The top searched job categories for Rn Rac Auditor jobs in Virginia are:
Rn Rac Auditor jobs near you
Infographic showing various Rn Rac Auditor job openings in Virginia as of June 2026, with employment types broken down into 64% Full Time, 4% Part Time, and 32% Contract. Highlights an 92% Physical, 4% Hybrid, and 4% Remote job distribution, with an average salary of $68,029 per year, or $32.7 per hour.
SIU Nurse Auditor, RN, CPC (Full-time, Remote)

SIU Nurse Auditor, RN, CPC (Full-time, Remote)

Integrity Management Services, Inc.

Alexandria, VA • On-site, Remote

Full-time

Posted 9 days ago

Job description

Job Title: Clinical Nurse Auditor - Payment Integrity
Job Summary
We are seeking an experienced Clinical Nurse Auditor to join our Payment Integrity team. In this role, you will leverage your clinical expertise, medical coding proficiency, and auditing skills to identify, monitor, and analyze unusual utilization patterns and potential fraud by healthcare providers. You will conduct prepayment claims reviews, post-payment audits, and comprehensive provider record reviews to ensure accurate billing, compliance with payer regulations, and integrity in reimbursement practices. This position requires a Registered Nurse (RN) with coding certifications such as CPC (Certified Professional Coder), CIC (Certified Inpatient Coder), CDI (Clinical Documentation Improvement), or a similar credential, through AAPC or AHIMA. Knowledge of commercial insurance plans, Medicare, and Medicaid programs is essential.
How You Will Make an Impact
  • Investigations and Audits: Conduct in-depth medical reviews through prepayment claims review and post-payment auditing to identify potential over-utilization or fraudulent activities.
  • Tool and Policy Development: Assist in the creation of audit tools, policies, procedures, and educational materials to enhance audit effectiveness and maintain high standards in payment integrity.
  • Cross-Departmental Collaboration: Serve as a liaison with service operations and other departments to provide status updates on claims reviews and coordinate actions as needed.
  • Data Analysis and Trending: Analyze performance data to identify patterns and trends, collaborate with service operations to address process improvements, and recommend modifications to medical policy.
  • Fraud Detection Support: Support fraud investigators with medical review expertise to detect and address fraudulent activities.
  • Mentorship: Act as a resource and mentor to other nurse auditors, supporting their professional growth and development in audit practices.

Requirements
Qualifications
  • Education:
    • Minimum Associate's Degree in Nursing required;
  • Licensure & Certification:
    • Current, unrestricted Registered Nurse (RN) license in applicable state(s).
    • Certification in medical coding from AAPC or AHIMA (e.g., CPC, CIC, CDI, or equivalent) is highly preferred.
  • Experience:
    • Minimum 5 years of clinical nursing experience, preferably with exposure to hospital bill auditing or defense auditing.
    • Strong knowledge of provider manuals, reimbursement policies, and medical policy guidelines.
    • Prior experience with healthcare fraud investigation and auditing is highly preferred.
  • Skills:
    • Proficiency in CPT/HCPCS and ICD-10 coding, with a strong foundation in auditing, accounting, and control principles.
    • Analytical and problem-solving skills with a keen attention to detail.
    • Exceptional written and verbal communication skills for clear and effective reporting and provider engagement.
    • Strong proficiency in Microsoft Office and familiarity with audit tracking systems.

Preferred Traits
  • Meticulous, organized, and objective in analyzing claims and documentation.
  • Ethical and responsible, with a commitment to supporting the integrity of healthcare billing and reimbursement.
  • Able to work independently, stay current with rapidly changing healthcare regulations, and thrive in a fast-paced environment.

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